Baldness remedies – what works and what doesn't?

People have always been gullible where their hair is concerned. Queen Victoria drank silver birch wine made from sap because she believed it would cure her baldness.

Dr Andrew Messenger, a consultant dermatologist at Royal Hallamshire Hospital in Sheffield, told NetDoctor: 'Although the great majority of men learn to live with it, I think everybody would prefer not to be bald. For a very small number of men, it becomes a big issue.'

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He says it is more often younger men who visit their doctor to ask what can be done about hair thinning.

Medical attitudes to thinning hair

Most doctors believe men should think deeply before using any remedies for hair loss because the treatment options are so limited.

Baldness isn't a life-threatening condition, and it is easy to spend a lot of money trying to restore a full head of hair.

While it's all very well being told how you ought to feel about the loss of your hair, if it starts to dint your self-esteem, it's probably worth seeking treatment.

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But Dr Messenger is clear about the limitations of medicine in this area: 'There are only two ways to deal with baldness currently available in the UK that the evidence shows work to at least some extent.' Neither of the medicines listed below is available on the NHS.

Minoxidil

Minoxidil is sold over the counter as a topical solution (liquid) under the brand name Regaine.

How does it work?

We don't know how minoxidil works. It was first used on patients with heart disease who reported an increased growth in their hair.

It may increase blood supply to the hair follicles.

How is it used?

It's applied twice a day, and it can take up to four months for the results to be noticeable.

Is it effective?

About two-thirds of the men who use it have some improvement in their hair growth, ranging from minimal to moderate-to-dense regrowth.

If hair starts to regrow, it will probably be soft, downy and barely visible. With continued use, this new hair may become the same colour and thickness as the rest of your hair.

Regrowth of hair can be as much as 25 per cent of the existing hair, depending on how bad the hair loss has been and how long it has been happening.

It is not possible to tell in advance whether minoxidil will work for you, and there's no evidence it works better in younger men. They may get better results because hair loss is not as severe, but this would apply to a man in middle age too.

It isn't known why minoxidil works for some people and not others.

Regaine Extra Strength is a higher strength version of minoxidil and has a slightly better effect.

The first sign of new hair begins to show after two months and it peaks at around one year.

In trials comparing the two strengths, Regaine Extra produced 43 per cent more regrowth than the regular strength after 12 months' use.

How long do the effects last?

Any benefits to hair growth will carry on for as long as you continue the twice-daily applications.

Once you stop using minoxidil, regrown hair will be lost after three to four months, and the balding process will start again.

'It can become a bit of a bind rubbing it into the scalp twice a day after it has stopped improving and you can't see anything happening,' says Dr Messenger. 'You also have to go on paying for it at the rate of about £25 per month.'

Is it safe?

Minoxidil is a safe treatment. Known side-effects include irritation of the scalp and the growth of hair on other parts of the body.

In some cases, loss of hair actually increases at first. If hair loss continues after two weeks, you should stop using the product and consult your doctor.

People with heart conditions should not use Regaine without first seeing their GP.

Finasteride

Finasteride is an oral tablet treatment for male baldness. In the UK its brand name is Propecia.

It is not available over the counter in shops or on the NHS: this means you will need to get a private prescription from your GP.

How does it work?

It works by inhibiting the action of an enzyme in the body called type II 5-alpha reductase. This enzyme is responsible for converting the male hormone testosterone into dihydrotestosterone (DHT).

DHT is a hormone that can damage hair follicles and lead to hair loss in men who are genetically sensitive to it.

How is it used?

You take one tablet every day, with or without food.

Is it effective?

Propecia is effective in about 80 per cent of men.

It may take three to six months of treatment before you see any noticeable results.

How long do the effects last?

You will need to continue to use Propecia to maintain any benefits to hair growth.

This can be expensive, because doctors can only prescribe the medicine on a private prescription.

If you stop taking the drug, you are likely to lose any hair you have gained within 9 to 12 months.

Is it safe?

Yes. Potential side-effects include sexual problems such as a decrease in sex drive and temporary impotence.

Women cannot take this treatment, nor should they handle any crushed or broken tablets. This is because the active ingredient can cause feminisation of a male foetus in pregnancy.

What if these treatments don't work?

There are no other clinically proven medicines for baldness.

In cases where medicines aren't effective, some men may be tempted to try a hair graft.

Hair replacement grafts

How does it work?

In a hair graft, surgery is used to take hair from the back of the scalp and transplant it to the bald patch where the hair grows as if it were still on the original site.

It is a minor operation done under local anaesthetic.

It can be done in several stages or in one mega session where thousands of hairs are involved.

The hair is now usually moved in micrografts - small groups of hairs - to get a more natural look. This helps avoid the graft resembling a doll's head.

Is it effective?

'A good result depends entirely on the surgeon's skill,' says Dr Messenger. 'I have seen some fairly good results but I don't think it ever looks completely natural.'

Is it safe?

The side-effects are the usual surgical risks of infection and scarring.

There is no known way of reversing this procedure, so if you aren't pleased with the results, you're stuck with it. The transplanted hairs will grow on in the same way as the hairs at the back of the head, which most men keep forever.

'I wouldn't recommend surgery hair grafts to anybody. I would let men know it's available, but that's all. I certainly wouldn't have it done myself. It is pretty bloody and traumatic,' says Dr Messenger.

What about claims for other products?

Dr David Fenton, a consultant dermatologist at St Thomas' Hospital in London, says men should be careful about adverts that claim to cure hair loss.

'Many of these people are offering treatments that have no scientific basis. Men wishing to restore their hair should stay well clear of them and get advice from doctors. Then they will be advised by people who are highly trained in their field, not salesmen with no medical background whatsoever.'

He also feels that men seeking help should be supported, given counselling and not belittled.

Where can I get help?

Your GP: consult your doctor before you hand over your money to anyone offering a cure for baldness.

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